<!DOCTYPE">
<html xmlns="">

	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1, user-scalable=no">
		<meta name="apple-mobile-web-app-capable" content="yes">
		<meta name="apple-mobile-web-app-status-bar-style" content="black">
		<title>分销商申请单</title>

		<link rel="stylesheet" type="text/css" href="../css/css.css" />
		<link rel="stylesheet" type="text/css" href="../css/iconfont.css" />
		<script type="text/javascript" src="../js/jquery.min.js"></script>
		<script src="../js/common.js" type="text/javascript" charset="utf-8"></script>
		<script type="text/javascript">
			$(function() {
				$(".multiOption li").click(function() {
					if ($(this).hasClass("cur")) {
						$(this).removeClass("cur");
					} else {
						$(this).addClass("cur");
					}
				});
			})
		</script>
	</head>

	<body>
		<div class="main">
			<header class="header">

				<div class="title">
					分销商申请表
				</div>
				<div class="backHome">
					<a href="">
						<i class="icon iconfont icon-shouye"></i>
					</a>
				</div>
			</header>
			<div class="form">
				<ul>
					<li>
						<p>申请人<span class="redFont">*</span></p>
						<input type="text" placeholder="请填写姓名" />
					</li>
					<li>
						<p>申请人电话<span class="redFont">*</span></p>
						<input type="text" placeholder="请填写电话号码" />
					</li>
					<li>
						<p>性别<span class="redFont">*</span></p>
						<select>
							<option value="0">保密</option>
							<option value="1">男</option>
							<option value="2">女</option>
						</select>
					</li>
					<li>
						<p>出生日期<span class="redFont">*</span></p>
						<select>
							<option value="">请选择日期</option>
						</select>
					</li>
					<li>
						<p>身份号码<span class="redFont">*</span></p>
						<input type="text" placeholder="请填写身份号码" />
					</li>
					</ul>
			</div>
			<div class="form">
				<ul>
					<li class="long">
						<p>住址<span class="redFont">*</span></p>
						<textarea rows="2" placeholder="请填写地址"></textarea>
					</li>
				</ul>
			</div>
			<!--<p class="subTitle marginTop">
				联系人信息
			</p>-->
			

		</div>
		<ul class="footButton">
			<li class="left">
				<a class="btn greenbg">
					<i class="icon iconfont icon-fenxiang marginRight"></i> 分享
				</a>
			</li>
			<li class="right">
				<a class="btn orangebg">
					<i class="icon iconfont icon-bianji marginRight"></i> 提交
				</a>
			</li>
		</ul>

	</body>

</html>